GI- GI Bleed

Question 1

GI Bleed in General

Answer 1

UGIB - Hematemesis, melena, hematochezia

LGIB - Melena, Hematochezia

React:

• 2 large bore IVs
• IVF Bolus
• Type and Cross, Transfuse as needed
• IV PPI
• Call GI for EGD

Octreotide (cirrhosis)
Ceftriaxone (cirrhosis)

Dx: UGIB: EGD first
LGIB: 
- colonoscopy (no bleeding)
- Arteriogram (really fast bleeding)
- Tagged RBC scan (slow bleeding)
- Pill-cam (last resort)

Question 2

Varices

Answer 2

Path: Portal HTN

Pt: Cirrhotic w GI bleed

Dx: EGD

Tx: Stabilize...
1st Octreotide 
Then: Balloon
EGD: Banding
Refractory: TIPS
Transplant 

F/u: Ceftriaxone for SBP prophylaxis

Question 3

Peptic Ulcer Disease

Answer 3

Path: H. pylori; NSAIDs, Ca, others

Pt: Dyspepsia, GI Bleed

Dx: EGD w Bx

Tx: PPI

Question 4

Mallory-Weiss

Answer 4

Path: Superficial tear in mucosa

Pt: weekend warriors, self-limiting

Dx: EGD

Tx: Supportive

Question 5

Boerhaaves

Answer 5

Path: transmural tear in mucosa

Pt: Alcohol/Bulimics, wretching
Fever, dyspnea
Air in mediastinum

Dx: 1st Gastrografin
Then: Barium
Best: EGD
EGD w Bx

Tx: Surgery

Question 6

Dieulafoy’s lesion

Answer 6

Path: normal variant

Pt: painless abrupt bleed

Dx: EGD

Tx: Subtotal gastrectomy

Question 7

Hemorrhoids

Answer 7

Path: internal: bleed but do not hurt
External: no bleed, but do hurt

Pt: Blood on toilet paper

Dx: Clx

Tx: Sitz baths (right arrow) banding

Question 8

Diverticular Hemorrhage

Answer 8

Path: Arteriole in dome of Diverticula

Pt: > 50 yrs old painless BRBPR

Dx: Colonscopy

Tx: hemicolectomy

Question 9

Mesenteric Ischemia

Answer 9

Path: “Gut Attack:

Pt: vasculopath, Afib, pain out of proportion (acute), h/o pain while eating, weight loss (chronic)

Dx: Angiogram
Colonoscopy

Tx: Revascularize
Resect

Question 10

Ischemic Colitis

Answer 10

Path: watershed areas

Pt: Hypotension first, then GI Bleed
Painful BRBPR

Dx: Colonoscopy

Tx: supportive

something below this about aortic stenosis and AVM….clarify